October 1977 · Vol. 6 No. 4 · pp. 22–28
Ethics and the New Biology
We live in a period of rapid growth, the rate of which is unprecedented in human history. Accompanying this growth is a rapidly changing technology which has provided us the basis for modern survival. In the middle of this exponential change sits the human species, whose evolution prepared it for a much simpler life. The human condition is further complicated by our inability to know which elements of our current technology are helping us to survive and which are helping to destroy us. This inability is due to the fact that contemporary society has no past experience with the perturbations caused by the impact of escalating technology on ourselves and our environment. The very fabric of our society seems threatened, unable to bear any more stress. And still the issues come and the trap becomes all the more pervasive. We are left in a quandary: Do we sink back into indecision and let come what may? Do we elect to forge ahead ever hoping for the best? Or do we abandon our current technologies and institutions as simply too threatening? Each of these solutions has numerous advocates.
NEW PROBLEMS: UNDERSTOOD AND MISUNDERSTOOD
A whole new set of issues has arisen from the avalanche of new biological discoveries and revolutionary medical techniques as well as from a new understanding of the fundamental processes of life. But the new biology, with its potential for good, creates conflict. Suddenly we are faced with choices to which our beleaguered society responds hesitantly at best, non-existently at worst. Should defective children be aborted? Is parenthood a right or a privilege? Is there a right to life or does societal good take precedence? Will only those members of a society who can afford life-prolonging and expensive medical care be so treated? Are all citizens entitled to equal and adequate health care? {23} What are the dangers that an over-medicated society may lose its sense of identity? Do we, as a nation of affluence and surpluses, have the right to dictate population policy to poorer nations, even to the point of refusing aid if they fail to comply with our demands? Should we allow them on our life boat? Are there moral responsibilities toward the environment? Do we have any obligations to those yet unborn? We are, in a very real way, in the midst of a revolution, a biological revolution, in which the real issue is: how are we to insure for ourselves, and for future generations as well, that the new forces coming out of this revolution are going to be harnessed for the common good?
The issue is not whether there is to be more or less biology. The burgeoning birth rate, the imminence of world famine, the continued researches in biomedicine aimed at alleviating human ills, the new techniques for identification of potential physical disability before onset of clinical symptoms—these things have settled the question of whether or not there will be more science. The world has already been shifted so far in favor of complex technology that we run the risk of losing any hope for future solutions if we abandon our current technology. The real issue is by what method shall we evaluate the uses of the new science. Or, stated more bluntly, who is to be in control? Are we going to let science control itself or are we going to control science?
What are these new technologies? Some of them can be cited. But before considering what these might be, it will be helpful to describe what they are not and in this way to dispel the Orwellian bogeyman which is so often the picture the layperson has of the new biology. Much of what one encounters in the popular press concerning the application of biological advances speaks to far-out consequences, usually of the kind that evoke the specter of a Brave New World, of Doctors Strangelove and Frankenstein.
Human cloning, man-ape chimeras, creating persons according to genetic specification, pre-assignment to an intellectual caste, mass control of behavior by chemical or physical manipulation, promises of immortality through various techniques from cryogenic freezing of bodies to serial replacements of worn-out body parts, destruction of the nuclear family (encouraged in part by new reproductive technologies), a continuing erosion of the traditional parent-authority relationship as yesterday’s knowledge is eclipsed by ever-new revelations—these and other immoralities, it is proposed, would inevitably lead to the overthrow of our most highly prized human virtues, a lowering of the value of human life, and the dissolution of democratic society.
If these are the perceptions of many, little wonder that thoughtful {24} persons become frightened when applications of modern science and technology are projected into the future.
These dramatic accounts that stimulate interest in non-professional audiences, although not in themselves necessarily wrong, describe experimental results with a minimum of context and qualification, ignoring for the most part major technical and theoretical obstacles to practical implementation. The frequent result is that such accounts convey the impression that a wide range of applications to biological, medical, and social problems will be possible in the near future. This is not necessarily the case. The unfortunate spin-off from this kind of reporting is not so much a disenchantment with science but rather a fear of it, a blaming of science for our problems. Such fear could lead to the rigid control of science or even to halting it altogether, rejecting thereby the great potential contributions of science to the “good life.”
In view of these misunderstandings of the “new” biology, what is needed is a more realistic estimate of the clinical and social applications that are likely to arise. Here most researchers in the biological sciences, including medical practitioners, are much less pessimistic about applications. I do not mean to suggest that within the wide range of possible uses there are to be found no substantive and serious ethical concerns. On the contrary, the ethical and social questions raised are numerous; and finding acceptable moral solutions will be enormously difficult.
So what are the real issues? I have already alluded to some, but let me simply list some of the issues we face already. In the area of genetic intervention, programs of gene therapy are being practiced. This is the procedure of treating individuals with genetic diseases so they can live more comfortably. This presents no real moral issue except when those individuals get to reproductive age or when the treatment gets so expensive that someone else has to pay the bill—or when programs of genetic screening and counseling raise another whole series of questions.
Another area of ethical and moral concern is in the advance of reproductive technologies. There are some difficult questions to be answered concerning artificial insemination, sex pre-determination, in vitro fertilization, contraception, abortion, and pre-natal diagnosis.
THE ETHICS OF ONE PROBLEM: PRE-NATAL DIAGNOSIS
The list could go on and on. However, because of my interest in human genetics and because the following example is an “easy” question to resolve, I would like to devote the rest of the article to the topic or pre-natal diagnosis via amniocentesis.
The technique called amniocentesis can be used to detect some {25} genetic defects of fetuses still in the womb. The principle involved is this: the fluid surrounding the fetus contains, among other things, a great many cells derived largely from the skin and respiratory tract of the fetus. In the procedure, a small amount of this fluid is withdrawn by needle puncture of the pregnant uterus or extraction through the cervical opening, usually 12 to 16 weeks after conception. The living cells are then removed from this fluid and grown in the laboratory. After a number of cells have been grown, examination for defects can be done.
All chromosomal abnormalities can be identified as well as a number of biochemical deficiencies. Altogether about 200 deficiencies can be detected using this procedure. All of these abnormalities will in some way affect the health of the developing fetus. Some of these abnormalities are very serious while others are not. Rapid progress is being made in this area and it has been predicted that by 1980 over 500 deficiencies will be detectable using amniocentesis.
Amniocentesis is a marvelous advance of modern medicine. It allows physicians to detect and diagnose diseases in the womb. In some cases diagnoses leads to treatment which allows the fetus to develop “normally.” In other cases, the diagnosis leads to a treatment which some find morally unacceptable—abortion. But what are the options in those cases?
Suppose that you were a physician with a patient, a Mrs. Toews (to keep the ethnicity in line), who suspects something may be wrong with her baby. She is about three months pregnant and she wants you to perform an amniocentesis. You agree that an amniocentesis is warranted and proceed. The results come back and indicate that she is in fact carrying a fetus which has an extra chromosome. The extra chromosome is the number 18 chromosome and you know that the baby will be born grossly deformed with many congenital defects. An enormous amount of time, effort, and money will have to be invested just to keep the baby alive. If the baby lives past the first few days, it will be severely mentally retarded (vegetative) and severely physically disabled. It will never respond to its parents or to other people in its environment and it will probably die before it is two years old.
You the physician, and you Mrs. Toews, are faced with a dilemma. Should this fetus be aborted? According to the official stance of our Mennonite Brethren Conference the answer is no, since the life of the mother is not in danger. However, should that be our only concern? What about the yet unborn fetus? Does it have the right to be born in any form or do our children have a right to be born healthy? What is our responsibility to our future children? On the other side of the question, what is our responsibility to ourselves and to those who are already alive? Do we have the right to force Mrs. Toews to have {26} that child? Or if she decides to abort the fetus, can we as a church body say that she has killed a human being?
Some will say that God gives us those children to teach us about Himself. Supposedly they teach us love, understanding, and compassion. God has also given us the intellectual ability to develop techniques like amniocentesis. What does that say about the potential uses of this technique?
Some have said (although in a slightly different context) that we should treat all living humans as our neighbors (Dyck, 1976). That is, we should live by the Good Samaritan ethic. My question is, then, who is my neighbor? Is it Mrs. Toews or her fetus? The obvious answer is that both are my neighbor. We should do all in our power to help both to achieve a meaningful and happy existence. Or quite possibly our concern should not be with “meaningful and happy,” just “existence.” If our concern is with existence, then I agree that we should do all in our power to keep that fetus alive at all costs. However, if our concern is for some kind of meaning and relation in our lives, then we need to do some more thinking. Can a baby who is born severely handicapped, both mentally and physically, ever achieve a meaningful existence? It might be that for beings like this the most meaningful existence is no existence. All of us who are living tend to think it is better to live than not to live. It might be that in some cases it is better not to live than to live with very meager abilities.
The question to which we need to address ourselves as a brotherhood and as a Christian body is that of “humanhood.” That is, instead of trying to come up with all sorts of rules to cover us in a variety of situations in this area, let us concentrate on the question of what it means to be human. What has God told us about being human? Can we assume that everything that has human parents is necessarily human? Is the conceptus a human being? Or is it only potentially human? Is a fetus that is severely deformed a human being? Or for that matter is any fetus a human being? Or is a fetus only potentially human: If they are only potentially human are all of them potentially human?
This is an area from which many of us shy away because we do not want to play God. I do not feel we are playing God if we begin to grapple with these issues. We have developed technologies which make us face these issues, and we should then take the responsibilities of facing those issues and attempting to answer them in some meaningful Christian way. There have been attempts made in the past. Fletcher (1972, 1974) has proposed a list of indicators for humanhood. While we may not agree with his list, it is a place to begin. {27}
ANOTHER PROBLEM: DEFECTIVE BABIES
There is another side to this issue. Suppose there was no reason for Mrs. Toews to suspect that anything was wrong with her baby and after nine months she delivered a severely defective child. Now what should she do? And what are the issues faced by her physician and by us, her community of believers?
Of the babies born in the U.S. every year, the great majority (90%-95%) arrive in perfect health. The remaining, however, are doomed from the moment of their first breath, and someone must decide whether or not to keep the child alive. The moral question is this: is it perhaps the ultimate kindness to let the child die naturally, or more beneficially, to hasten its death? In times past this was no problem, for nature provided the solution of imminent and usually rapid death. But developing medical technology can often prolong the life of the child indefinitely. The costs in terms of family torment, money, and hospital staff and facilities, as well as the psychic cruelty inflicted on the child itself, can be prohibitively high. Do babies, then, have the right to die when there is “little or no hope of achieving meaningful humanhood”? Many of these newborns, according to Duff and Campbell (1973), have “almost no capacity to be loved. They are cared for in facilities that have been characterized as hardly more than dying bins.” Duff and Campbell are calling for a public and open debate on the question: “The public has got to decide what to do with vegetated individuals who have no human potential.” The medical profession can not solve these problems alone.
One view on this question submits that such defective infants should not be permitted to suffer a “lingering, painful and inhumane death” (Prescott, 1975). It is contended that simply allowing these babies to die, even when efforts are made to spare the infant pain, is immoral, for many times the hopelessly damaged newborn is permitted to starve to death. Prescott suggests that in these cases the life of the infant should be quickly, peacefully, and compassionately terminated (active euthanasia).
Both of these situations raise many ethical and moral questions, questions which are being asked by many “secular” people. It is past time that we as a Christian community begin to grapple with these issues in more than a superficial way. These questions do not have easy black and white answers. They do not have easy Scriptural answers, but I am convinced that our Christianity must have something to say.
I must confess that I do not have answers to these issues. If anything I only have additional questions. I must also confess that I am a Christian who has not resolved the abortion and/or euthanasia issues. To be sure I do not advocate abortion as a means of birth {28} control or the wholesale use of euthanasia for treatment of the terminally ill. However, there are instances where these options might be the lesser of two (or more) evils. But to decide between the evils is an extremely difficult task. It is a task, however, that I strongly believe we as Christians should undertake.
BIBLIOGRAPHY
- Bok, Sissela, 1974. “Ethical Problems of Abortion.” Hasting’s Center Studies, 2 (1), January, 1974.
- Callahan, Daniel, 1972. “Abortion: A Summary of the Arguments.” Aspects of Population Growth Policy, Vol. VI, U.S. Government Printing Office, Washington, D.C.
- Dyck, A. J., “The Value of Life: Two Contending Policies.” Harvard Magazine, January, 1976.
- Duff and Campbell, 1973. “Shall This Child Die?” Newsweek, November 12, 1973, p. 70.
- Fletcher, Joseph, 1972. “Indicators of Humanhood: A Tentative Profile of Man.” The Hasting’s Center Report, 2 (5), November, 1972.
- Fletcher, Joseph, 1974. “Four Indicators of Humanhood: The Enquiry Matures.” The Hasting’s Center Report, 4 (6), December, 1974.
- Gustafson, James, 1975. “Intensive Care for Newborns: Are There Times to Pull the Plug?” Science, 188, April 11, 1975.
- Hardin, Garrett, 1974. “Living on a Lifeboat.” Bioscience, 24 (10), October, 1974.
- Kelsey, Beverly, 1975. “Which Infants Shall Live? Who Shall Decide?” The Hasting’s Center Report, 5 (2), April, 1975.
- Powledge, T. and Sollitto, S., 1974. “Prenatal Diagnosis—The Past and the Future.” The Hasting’s Center Report 4 (5), November, 1974.
- Prescott, James W., 1975. “Abortion or the Unwanted Child: A Choice for a Humanistic Society.” The Humanist, 35 (2), March/April, 1975.
